Spinal Cord Stimulator Trial and Implant: What is it?

Spinal cord stimulators (SCS) are innovative medical devices designed to alleviate chronic and persistent pain by delivering electrical signals to the spinal cord. Implanted under the skin, these devices work by intercepting pain signals before they reach the brain, replacing sensations of pain with a mild tingling or buzzing feeling. SCS is often recommended for patients who have not found relief from traditional pain management methods and can significantly improve their quality of life.

Spinal cord stimulators comprise delicate wires known as electrodes and a compact battery pack resembling a pacemaker, referred to as the generator. These electrodes are positioned in the epidural space between the spinal cord and vertebrae, while the generator is placed beneath the skin, typically near the buttocks or abdomen. By employing a remote control, patients can transmit electrical impulses when they experience pain. Both the remote control and its antenna are located externally.

While the precise mechanisms of spinal cord stimulation remain somewhat elusive to experts, it has been discovered that this therapy can potentially target multiple muscle groups directly from the spinal cord and even modify the brain’s perception of pain.

Conventional spinal cord stimulators generate a gentle tingling sensation known as paresthesia, effectively replacing the feeling of pain. However, for patients who find these tingling sensations uncomfortable, newer devices provide “sub-perception” stimulation that cannot be consciously felt.

In recent times, highly trained physicians specializing in interventional pain management employ X-ray and/or ultrasound guidance to precisely implant many of the latest spinal cord stimulation devices.

Spinal cord stimulation is frequently employed when non-surgical approaches for pain relief have proved insufficient. This technique is utilized to address various types of chronic pain, which include:

1. Back pain, particularly when it persists even after undergoing surgery (known as failed back surgery syndrome)
2. Post-surgical pain
3. Arachnoiditis, which refers to the painful inflammation of the arachnoid, a thin membrane covering the brain and spinal cord
4. Intractable angina (heart pain) that is unresponsive to other treatment methods
5. Spinal cord injuries
6. Nerve-related pain, such as severe diabetic neuropathy and neuropathy associated with cancer resulting from radiation, surgery, or chemotherapy
7. Peripheral vascular disease
8. Complex regional pain syndrome
9. Pain following amputation
10. Visceral abdominal pain and perineal pain

By incorporating spinal cord stimulation into a comprehensive pain management approach, patients can experience enhancements in their overall quality of life and sleep, while reducing their reliance on pain medications. This treatment is typically combined with other therapies, including medications, exercise, physical therapy, and relaxation techniques.

Prior to recommending spinal cord stimulation as a treatment option for chronic pain, your doctor will carefully assess its suitability and the potential for substantial pain relief. This evaluation may involve ordering imaging tests and conducting psychological screenings. Some insurance providers may also require psychological screening to ensure that conditions such as depression or anxiety are not exacerbating the pain.

While individual circumstances vary, individuals who typically derive the greatest benefit from spinal cord stimulation are those who:

1. Have not achieved satisfactory pain relief through the use of medications, less invasive therapies, or previous surgeries.
2. Do not have psychiatric disorders that could diminish the effectiveness of the procedure.

Spinal Cord Stimulator Trial:

To begin the process, a trial period is conducted. During this stage, your surgeon will implant a temporary device for you to evaluate. With the guidance of fluoroscopy, a specialized X-ray, the surgeon will carefully insert the electrodes into the epidural space of the spine. The placement of the electrodes along the spine will depend on the location of your pain. Throughout the procedure, your surgeon may request your feedback to ensure optimal electrode positioning.

Typically, only one incision is made in your lower back to place the electrodes during the trial. The generator or battery will remain outside the body, usually attached to a belt that you wear around your waist.

Over the course of approximately one week, you will assess how effectively the device reduces your pain. The trial is considered successful if you experience a 50% or greater reduction in pain level.

If the trial is unsuccessful, the wires can be easily removed in a clinic setting without causing damage to the spinal cord or nerves. If the trial is successful, surgery is scheduled to permanently implant the device.

During the permanent implantation procedure, the generator is placed beneath the skin, and the trial electrodes are replaced with sterile electrodes. Unlike the trial electrodes, the permanent electrodes are anchored using sutures to minimize movement.

The implantation procedure typically takes around 1-2 hours and is usually performed on an outpatient basis.

After administering local anesthesia, your surgeon will make one incision, typically along your lower abdomen or buttocks, to accommodate the generator. Another incision will be made along your spine to insert the permanent electrodes. These incisions are approximately the size of a driver’s license. Similar to the trial procedure, fluoroscopy is used to determine the optimal placement of the electrodes.

Once the electrodes and generator are connected and functioning, your surgeon will close the incisions.

To ensure your comfort, your surgeon may provide sedation during the electrode placement and ask for your feedback throughout the process.

In conclusion, spinal cord stimulator therapy stands as a promising and effective option for individuals suffering from chronic pain who have exhausted conventional treatments. This cutting-edge medical technology offers a potential gateway to a life with reduced pain, improved mobility, and enhanced overall well-being. With ongoing advancements in the field, the future of spinal cord stimulator therapy holds even greater potential in transforming the lives of countless patients worldwide, providing hope for a brighter and more pain-free tomorrow.